A Time Apart: A Retreat for those who are grieving




Who is filling out this form?
First Name
Last Name
Who are the participants?
*First Name *Last Name *Address 1 Address 2 *City *State *Zip *Phone *Email
*Choose your registration options
Day Retreat only 10am-5pm ($70)
Overnight stay on 11/2 with dinner and hot breakfast ($119)
Overnight stay on 11/3 with dinner and hot breakfast and special evening program ($119)
Dietary Restrictions
Gluten Free
Dairy Free
Sugar Free
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$10 ($10)
$25 ($25)
$50 ($50)
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CANCELLATION POLICY:  Should we need to cancel an event, you will receive a full refund OR YOU MAY APPLY THE AMOUNT TO ANOTHER PROGRAM. If you decide to cancel for any reason, your registration will be refunded minus a $25.00 processing fee if you notify Rolling Ridge by phone or mail at least 7days in advance of the event. Registration FEES are non-refundable if you cancel within 7 days of the program.  All Prices are Subject to Change.

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